Provider Demographics
NPI:1255436341
Name:BUCK, AMY FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:FREDERICK
Last Name:BUCK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1221 BYRON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1069
Mailing Address - Country:US
Mailing Address - Phone:517-552-3132
Mailing Address - Fax:517-552-8463
Practice Address - Street 1:1221 BYRON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1069
Practice Address - Country:US
Practice Address - Phone:517-552-3132
Practice Address - Fax:517-552-8463
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0005986696OtherAETNA ID
MI2301007587OtherLICENSE
MI133263OtherPREFERRED CHOICE ID
MI4242251Medicaid
MI4242251Medicaid
MI133263OtherPREFERRED CHOICE ID